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Generally speaking, Glick's research on rats has shown that ibogaine "dampens" the brain's so-called reward pathway, reducing the release of neurotransmitters, such as dopamine, that cause the highs associated with everything from heroin to sugary foods. Ibogaine has also been proved to increase production of GDNF, a type of protein that quells cravings, and to block the brain's nicotinic receptors, the same spots that are stimulated by tobacco and other addictive substances.
Mash, the researcher from Miami, is convinced that ibogaine works long term because it is stored in fat cells and processed by the liver into a metabolite called noribogaine that possesses powerful detoxifying and antidepressant properties.
"If you gave somebody LSD or psilocybin, and they were coming off opiates or meth, they'd go right back out and shoot up," Mash says. "There's evidence that it's not the visions that get you drug-free; it is the ability of the metabolite to block the craving and block the signs and symptoms of opiate withdrawal and improve mood."
Though they don't question its effectiveness, both Mash and Glick believe it's unlikely that ibogaine will ever be widely accepted in the United States. It's not just that ibogaine makes people hallucinate. It can be fatal.
Since 1991, at least 19 people have died during, or shortly after, undergoing ibogaine therapy. Alper, the NYU professor, examined the causes of the fatalities, which occurred between 1991 and 2008. His findings suggest that ibogaine itself was not the culprit; the patients died because they had heart problems or they combined the hallucinogen with a drug of choice. (By way of comparison, a study published last year by the Centers for Disease Control found that between 1999 and 2006, more than 4,600 people in the United States died from overdoses involving methadone.)
Three of the ibogaine-related deaths occurred at Wilkins' Tijuana clinic. Two involved patients who had cocaine in their systems, she says, and the third had a pre-existing heart condition. Wilkins says she's now more selective about her clients and requires that they undergo a drug test.
"The learning curve has been difficult at times, but people need to know this can be safe," Wilkins says. "We have to show people how far we've come."
Some of the scientists, however, think they've found alternatives that will make the risks — and the tripping — associated with ibogaine unnecessary.
Mash has devised two ways to isolate the metabolite noribogaine and administer it: (1) a pill and (2) a patch similar to the nicotine variety. She hopes to begin testing the products on humans by the end of this year.
"It has all the benefits without the adverse side effects, including no hallucinations," Mash says. "I spent a lot of years really pushing ibogaine as far as I could, both in preclinical and clinical studies. But everything that I've learned in the course of 18 years of working on ibogaine has convinced me that the active metabolite is the drug to be developed."
Glick, meanwhile, teamed up with a chemist named Martin Kuehne, from the University of Vermont, to create and research a chemical called 18-MC (short for 18-methoxycoronaridine) that mimics ibogaine's effect on a specific nicotinic receptor. Just like ibogaine, 18-MC appears to work wonders on drug-addicted rats.
"Cocaine, meth, nicotine, morphine — we did the same studies with 18-MC, and it worked as well or better than ibogaine," Glick says. "We also have data that it will be useful in treating obesity. In animals, it blocks their intake of sweet and fatty foods without affecting their nutrient intake."